Competence, education and careers
in neonatal nursing:
RCN guidance
Debra Teasdale MSc, PGCLT, RN, ENB 405, 998, A19.
HoD Health, Wellbeing and Family, Canterbury Christ Church University
RCN PNIC Forum - now RCN Acute Care Forum
1. Career Development for Neonatal Nurses
Must be equitable, transparent and transferable
5 key components;
1. Level of practice
2. Minimum professional / educational requirements
3. Competence level / broad description of role
4. Continuous professional development
5. Relationship to SfH Career framework (2006)
( NB this is not the same as the KSF banding )
Novice / New Entrant (Level 5 SfH)
Minimum
professional /
educational
entry
requirements
Registered
Nurse (RN)
(Child or
Adult)
Or
Registered
Midwife (RM).
Diploma /
degree
qualification.
Continuous Professional
Development
Competence level and broad
description of level of
practice/ role.
Preceptorship programme for
newly qualified staff
Induction/Foundation
education in neonatal care.
To remain in role
1. Work toward degree
qualification (if diplomate)
2. I year post qualification NMC Approved Mentorship
Course.
3. Continuous updating to
remain contemporary
Achieves and maintains
Competence and Core skills
for new entrants.
Initially - acquires basic skills
and knowledge for practice for
supervised practice in special
care. Once practice level has
reached consistently high
standards this role may extend
to high dependency care
under supervision, prior to
undertaking post registration
qualification..
The novice neonatal nurse…
• …may remain at this level, maintaining competence
but should be encouraged and supported to develop
further to prepare for the specialist course.
• Or undertake post registration qualification in
Neonatal nursing (special, high dependency and
intensive care) to support development of
Competence and Core Skill as neonatal nurse (QIS)
status
• And works towards Neonatal Nurse (QIS)
Competence and Core Skills under direct supervision
of NMC qualified mentor in high dependency and
Intensive care environments……to become….
Competent QIS Nurse - SfH Level 6
Minimum professional / Continuous Professional
educational entry
Development
requirements
RN (Child/Adult) or
RM
To remain in role
1.Consolidates
knowledge and skills
Post registration
development
neonatal
2. Continuous
updating to remain
qualification
contemporary.
Engaged with degree 3. NMC approved
Sign-off mentorship
level study
NMC mentor
programme
Competence level and
broad description of
level of practice/ role.
Achieves and
maintains Neonatal
Nurse (QIS)
Competence and
Core Skills
The neonatal nurse
is qualified to within
all areas of neonatal
care.
The Competent neonatal nurse may…..
• The neonatal nurse may remain at this level,
maintaining competence or may choose to develop
further.
• Undertake study in neonatal nursing at honours
degree/postgraduate level to support development of
competence and core skill at experienced neonatal
nurse status and potential role development.
• Works towards competence and core skills for
experienced neonatal nurses under the supervision of
an experienced nurse with sign-off mentor
qualification.
Proficient QIS nurse – SfH level 6/7
Minimum
professional /
educational entry
requirements
RN (Child/Adult) or
RM
Post registration
neonatal qualification
NMS Sign off mentor
qualification
Honours degree
qualification or
recognition of prior
experiential learning
in clinical, education,
leadership or
management roles.
Continuous
Professional
Development
Competence level and broad
description of level of practice/
role.
To remain in role
1.Consolidates
knowledge and skills
development
2. Continuous
updating to remain
contemporary.
3. NMC approved
Practice
educator/lecturer
programme for those
leading in-house / HE
education
Achieves and maintains
Competence and Core Clinical
skills for experienced neonatal
nurses.
Experienced neonatal nurses
work in prescribed nursing roles
such as Neonatal
Transportation, Shift
Management Roles (eg Ward
Charge Nurse/Sister),
Development care Lead,
Lactation support, Community
Outreach Practitioner, Practice
Development/clinical educator
The Proficient Neonatal Nurse may…
• The neonatal nurse may remain at this level,
maintaining competence or may choose to develop
further.
• Undertake postgraduate study to support future role
development and the development of competence as
an expert neonatal nurse.
• For clinical practice role development works towards
Core Skills for expert neonatal nurses (or locally
determined equivalent) under supervision (expert
nurse with an NMC approved sign-off mentor
qualification or an appropriately qualified member of
the medical team)
Expert QIS nurse – SfH Level 7/8
Minimum professional
Continuous
/ educational entry
Professional
requirements
Development
RN (Child/Adult) or RM To remain in role
1.Consolidates
Post registration
knowledge and
neonatal qualification skills development
2. Continuous
NMC Mentor /Practice updating to remain
Educator qualification contemporary.
Educated to Masters
3. Access to
Doctoral and post level.
Doctoral study to
Recognition of prior
advance neonatal
experiential learning in nursing in the
clinical, education,
future.
leadership or
management roles
Competence level and broad
description of level of practice/
role.
Achieves and maintains
competence for expert neonatal
nurses.
For those in clinical practice
expert roles, achieves and sustain
core clinical skills set as specified
within expert level or as locally
determined.
Expert neonatal nurse roles
include Neonatal Unit Manager,
Neonatal Practice Development,
Facilitator/Researcher, established
Advanced Neonatal Nurse
Practitioner, Neonatal Nurse
Consultant
The ANNP role
• All the problems with QIS recognition across
the country are mirrored within the ANNP role
• The guidance recognises that ANNP
development is a journey and that roles are
disparate
• To address this it provides exemplar job
outlines agreed by representatives across all 4
countries for trainee, ANNP, Senior ANNP
3. Competences: What has been determined?
Each unit shall
have a lead for;
All staff will undertake training to;
Breastfeeding
Developmental
needs and care of
the baby
Emotional and
psychological
support to families
Safeguarding
children
Palliative care
Bereavement
support
Education and
training
Support mothers to feed their infant appropriately
promote the use of breast milk and breastfeeding
Assess developmental needs
Prepare babies and families for discharge,
Support families in acquiring the knowledge and
skills they will need to care for their baby at home
provide emotional and psychological support to
families
Safeguarding children
Supporting families during bereavement
TOOLKIT FOR HIGH-QUALITY NEONATAL SERVICES
(DH 2009)
RCN Guidance; Competences for Neonatal
Nursing Careers
• Family centred and
developmental care implicit
• Competences embedded
across career journey.
• KSF (NHS, 2004) core
dimensions.
• Clear relationship to levels
of practice with increasing
complexity as careers
progress
• Where the primary remit is
clinical, this includes
demonstration of a core skill
set
• Communication and
interpersonal relationships
• Personal, professional and
people development
• Health, safety and security
• Service development
• Quality
• Equality, diversity and rights
• Responsibility for patient
care (Core skill set)
EG; Communication and Interpersonal relationships
• Including data processing and
management, production and
communication of information and
knowledge, and the design and
production of visual records.
• The neonatal nurse will use a wide
range of media to communicate
effectively with babies, parents,
carers and health care workers.
• The neonatal nurse will demonstrate
interpersonal behaviour and skills
conducive to developing and
maintaining therapeutic and
professional relationships.
The elements of this are;
•
•
•
•
•
Communicate effectively with
babies, families, relatives, carers
and other professional colleagues.
Act as the neonate’s advocate.
Maintain effective and supportive
communication within the neonatal
nursing team and with other
professionals.
Contribute to creating an
environment that fosters open
communication and trust with
families and colleagues.
Liaise with health care
professionals and individuals in
other disciplines from within and
outside the organisation to support
quality patient care.
New entrant
(Novice)
Neonatal nurse
(QIS) [Competent ]
Experienced
neonatal nurse
[Proficient]
Expert neonatal nurse
Understand the
importance of
effective
communication.
• Demonstrate the
ability to
communicate
effectively and
efficiently with
colleagues.
• Communicate
tactfully,
maintaining trust,
integrity and
confidence.
Develop a rapport
and communicate
effectively within
the neonatal team
and with other
health care.
professionals,
about routine and
daily activities,
overcoming
differences that
may exist.
Process, modify and
manage data and
information.
• Write complex
reports.
• Prepare and
deliver
presentations.
• Establish and
maintain
communication with
individuals and
groups about
complex and difficult
neonatal matters,
over coming
problems.
Influence strategic
policy making at local
and national
level.
• Lead meetings, give
presentations and
influence a
wide range of
individuals and
groups at strategic level
to take
action and make
changes.
• Receive and process
complex, sensitive and
contentious
information, initiating
actions required.
3a) CORE SKILLS SET
Core skills specifically relate to patient care (Responsibility for
patient care).
• Fluid, electrolyte, nutrition & elimination management
• Neurological & pain management
• Respiratory & cardiovascular management
• Skin, hygiene & infection control management
• Temperature management
• Bereavement management
• Investigations & procedures
• Equipment
New Entrant
Competent QIS
Proficient QIS
Recognise normal
behaviour in babies
of different
gestations,
including sleep/
awake states.
• Report deviations
from normal.
Recognise
physiological and
behavioural
differences
between stress,
distress, discomfort,
pain, convulsions
and drug
withdrawal.
Provide anticipatory Initiate referrals
guidance and
based
support for
on need.
staff to recognise
physiological and
behavioural
differences.
• Alleviate
neonate’s
discomfort, pain etc
using standard
nursing strategies
Expert
New Entrant
Competent QIS
Proficient QIS
Expert
Safely administer
intravenous therapy
according to unit
guidelines,
recognising
and reporting
deviations/
complications.
Set up, maintain
and
discontinue
intravenous/intraarterial
therapy, according
to unit
guidelines.
• Maintain central
lines.
• Intervene
appropriately to
reduce/avoid
deviations/
complications.
In specific
situations, insert
peripheral
intravenous
lines.
• Supervise
insertion of
intravenous lines by
others.
• Manage
appropriate
treatment for
deviations/complica
tions
• Establish
intravenous and
intra-arterial
access.
• Remove central
lines.
• Instigate and
prescribe
treatment.
• Select and
prescribe
appropriate fluid
management.
• Devise, audit and
review guidelines
for best practice
in partnership with
medical staff.
4. Recommendations
Four Areas for action
•
•
•
•
Recruitment and retention
Partnerships with educational providers
Developing a relevant curriculum
Continuing professional development
RCN guidance - working in practice.
Foundation Course ;
• New entrant competences provides focus for in-house
course in practice under supervision of mentor / practice
educator
QIS Staff new to the unit;
• Competence grid can be used to assess capabilities and
then create action plan where development needed, or
provide clear rationale for accelerated career progress.
Established staff;
• Allows prior practical experience of staff to be
acknowledged and education plan individualised
• Supports network approach to maintaining currency of
knowledge and skills (rotational posts) .
Partnership with education providers
Educational needs analysis
• Use to inform and map workforce development and
educational plans in practice
Working with education partners;
• ‘Competent’ level competences and skill set to
determine practice outcomes for QIS courses in APT
• Placements to support care level development
• Influence child and midwifery pre-reg’ programmes
so potential recruitment pool becomes wider (must
have neonatal content and 4 week placement)
Demonstrating FtP
Developing robust performance management;
• Use the Career grid to guide expected educational
attainment/ development pathways
• Use competence levels to determine the required FtP
standard to be met to as part of appraisal and/or
promotion process
Commissioners
• Using this as a benchmark in commissioning process
for neonatal nursing care delivery
• Should extend to educational commissioning also
Thank you